Cerebrovascular disease of Brain CT SIM HO YONG 2008 , 03 , 15 Masan samsung medical center

CT Angio, Colonography

Percentage of smc Brain CT ,2007

Percentage of cerebrovascular dz ,2007

ANATOMY Intracranial vascular anatomy Basal ganglia anatomy

Anterior communicating artery Perforating artery Hypothalamic artery Anterior cerebral artery Recurrent artery Ophthalmic artery Lenculostriate artery Internal carotid artery Middle cerebral artery Posterior communicating artery Posterior cerebral artery Anterior choroidal artery Superior cerebellar artery Perforating artery Basilar artery Long and short pontine artery Perforating artery Anterior inferior cerebellar artery Vertebral artery

Head of caudate nucleus Interthalamic adhesion Basal ganglia Corpus callosum Head of caudate nucleus lateral ventricle Putamen Interthalamic adhesion Globus pallidus 3rd ventricle Thalamus Pineal body

Anterior cerebral A (ACA) Callosomarginal A Pericallosal A Frontopolar A Orbital A

Middle cerebral A (MCA)

Posterior communicating A Acom. Pcom. ICA

PCA

Posterior cerebral A (PCA) Superior cerebellar A (SCA) Branches of the VBA Posterior cerebral A (PCA) Superior cerebellar A (SCA) Anterior inferior cerebellar A (AICA) Posterio inferior cerebellar A (PICA) SCA AICA

뇌혈관질환의 병리학적 분류 Occlusive cerebrovascular diseases Hemorrhagic cerebrovascular diseases

Ischemic cerebrovascular dz Transient ischemic attack : TIA Reversible ischemic neurologic deficit : RIND Progressing stroke Completed stroke

Ischemic Cerebrovascular dz 50~55ml/100g/min Ischemic threshold Threshold of electrical failure; 15~18ml/100g/min Threshold of ionic failure; 10~12ml/100g/min Ischemic penumbra; 10~20ml/100g/min

Cerebral Infarction(CI)

Transient Ischemic Attack(TIA)

Transient Ischemic Attack(TIA) ( CI )

Cerebral Infarction(CI)

Cerebral Infarction(CI)

대표적 뇌혈관질환 별 발생 빈도

Intracerebral Hemorrhage(ICH) Cause 1, Hypertension: 70% 2, Aneurysm: 20% 3, AVM: 5.6% 4, Other(CCF, Moyamoya dz, etc): 4.4% SMC(2007) Brain CT 1, Hypertension: 64.9% 2, Aneurysm: 31.3% 3, AVM: 1.6% 4, Other: 2.2%

Hypertensive Intracerebral Hemorrhage < Spontaneous Intracerebral Hemorrhage > Aneurysm AVM Moyamoya disease Hemorrhagic brain tumor

Hypertensive Intracerebral Hemorrhage Putaminal hemorrhage : 55% Thalamic hemorrhage : 10% Subcortical hemorrhage : 15% = Lobal hemorrhage Pontine hemorrhage Cerebellar hemorrhage : 20%

Hypertensive Intracerebral Hemorrhage Putaminal hemorrhage

Hypertensive Intracerebral Hemorrhage Thalamic hemorrhage

Hypertensive Intracerebral Hemorrhage Thalamic hemorrhage

Hypertensive Intracerebral Hemorrhage Subcortical hemorrhage = Lobal hemorrhage

Hypertensive Intracerebral Hemorrhage Subcortical hemorrhage = Lobal hemorrhage

Hypertensive Intracerebral Hemorrhage Pontine hemorrhage

Hypertensive Intracerebral Hemorrhage Cerebellar hemorrhage

Intracranial Aneurysm

Intracranial Aneurysm

Size Small < 10mm Large : 10-24mm Giant > 25mm Intracranial Aneurysm Size Small < 10mm Large : 10-24mm Giant > 25mm

Intracranial Aneurysm Anterior circulation :92% Internal carotid A:34% Anterior cerebral A:36% Middle cerebral A:19% Posterior circulation : 8% Basilar A Posterior cerebral A Cerebellar A Vertebral A

Intracranial Aneurysm Aneurysm at the Lt. anterior cerebral area.

Intracranial Aneurysm Aneurysm at the Lt. anterior cerebral area.

Intracranial Aneurysm Aneurysm at the middle cerebral bifurcation area.

Intracranial Aneurysm P-com area에 posterior direction의 aneurysmal sac이 보이고 size는 8mm 으로 측정됨. 25%

Intracranial Aneurysm P-com area에 posterior direction의 aneurysmal sac. – post clipping -

Intracranial Aneurysm RT vertebral artery aneurysm

Arteriovenous Malformation

Carotid Cavernous Fistula(CCF) Enlarged enhancing Rt. cavernous sinus with engorged Rt. superior ophthalmic vein.

Moya moya disease

Moya moya disease

감사합니다.